The objective: to evaluate the efficiency of chemotherapy with bedaquiline in pulmonary tuberculosis patients with multiple drug resistance. Subjects and methods. The chemotherapy efficiency was studied in 70 tuberculosis patients with extensive (XDR) or multiple (MDR) drug resistance who were treated in clinics of Central Tuberculosis Research Institute. All patients were divided into 3 groups: Group 1 (10 persons) included MDR TB patients, Group 2 (32 persons) included pre-XDR TB patients, Group 3 (28 persons) included XDR TB patients. Results of the study. High treatment efficiency in this difficult category of pulmonary tuberculosis patients with MDR and XDR was achieved when bedaquiline was added to the chemotherapy regimen. Upon the completion of the main treatment course with bedaquiline, in the group of patients with MDR and pre-XDR the sputum conversion was achieved in 100%, and in XDR tuberculosis patients the sputum conversion rate made 89.3%. The long-term treatment course with bedaquiline promoted the fastest sputum conversion, healing of cavities in the lungs of patients with disseminated tuberculosis and XDR, and it was not associated with a higher frequency of adverse events. © 2018 New Terra Publishing House. All rights reserved.